Author Of 1 Presentation
EVALUATION OF A 30 MG/KG AMIKACIN DAILY DOSE ON THE ACHIEVEMENT OF THE PLASMA PEAK TARGET IN CRITICALLY ILL CHILDREN
Abstract
Background
Amikacin efficacy requires a plasma peak concentration (Cmax) > 8-10 times the minimal inhibitory concentration (MIC) corresponding to a Cmax between 60-80 mg/l. The recommended 30 mg/kg dose was evaluated in critically ill adult leading to underexposure in 20% of patients but was not evaluated in critically ill children.
Objectives
We aimed to assess the incidence and factors associated with a Cmax < 60 mg/L in critically ill children treated with a 30 mg/kg dose of amikacine.
Methods
Retrospective observational multicentric study, from November 2017 to June 2018 in two pediatric intensive care unit (PICU) located within two French tertiary academic pediatric hospitals. We included all children admitted in the PICU receiving 30 mg/kg amikacin dose.
Results
We analyzed 24 children. Cmax was < 60 mg/L in 16 patients (67%). None had Cmax > 80 mg/L. Thirteen (93%) patients from the 14 having a measured MIC achieved a Cmax /MIC > 8. Higher level of uremia was significantly associated with a Cmax < 60 mg/L. We observed an occurrence or a worsening of acute kidney injury in 12 (50%) of our patients after amikacin injection. Trough concentration was > 2.5 mg/L in 40% of our patients.
Conclusion
Despite the use of a 30 mg/kg amikacin dose, Cmax were below pharmacokinetic target in 67% of our population and no Cmax was above. However, kidney function was impaired in half of our patients. This reinforces the need to monitor systematically peak and trough concentration in this vulnerable population receiving high doses of aminoglycosides.